Serum Amylase and Lipase Levels in Acute Patients with Pancreatitis Versus Nonpancreatic Abdominal Pain

Abstract

The serum amylase level may be elevated in acute pancreatitis, as well as other conditions which may present with abdominal pain. Conversely, normoamylasemia in acute pancreatitis is not uncommon. Some authors have suggested that serum lipase is a better serum masker for the diagnosis of acute pancreatitis. We conducted a study to evaluate: (1). the differences in serum amylase and lipase levels between patients with acute pancreatitis and those with nonpancreatic abdominal conditions. (2). the diagnostic accuracy of serum amylase and lipase levels between these two groups. The serum amylase and lipase levels were estimated in 47 patients with acute pancreatitis and 30 patients with nonpancreatic abdominal pain. Four (8.5%) patients had normoamylasemia in the acute pancreatitis group, however, almost all the patients in this group had elevated serum lipase levels. Elevated serum amylase levels in eleven (36.7%) and serum lipase levels in four (13.3%) patients were noted in the nonpancreatic abdominal pain group. Ten (33.3%) patients in the nonpancreatic abdominal pain group had serum amylase levels that overlapped those found in the acute pancreatitis patients. Only one (3.3%) patient in this group had serum lipase level that overlapped those found in acute pancreatitis patients. The sensitivity, specificity and the accuracy of the serum lipase levels in the diagnosis of acute pancreatitis were 100%, 86.7% and 94.8%, respectively. These were better than those of the serum amylase levels of 91.5%, 63.3% and 80.5%, respectively. If a higher cutoff value was chosen, that was 1.3 times the upper limit of normal, the sensitivity, specificity and the accuracy for serum lipase would be 100%, 96.7% and 98.7%, respectively and serum amylase 89.4%, 90% and 89.6%, respectively.